What's New with HCFO - June 22, 2005 (Print All Articles)

Hot Topic--Medicaid Reform: Balancing Care, Coverage, and Cost

In 2004, the total costs nationally for Medicaid were about $295 billion.   In addition, Medicaid is growing rapidly as a portion of state budgets.  However, despite the large overall expense, the challenge with Medicaid reform efforts is to cut costs from what is “already a lean program, spending less per person than private insurance after adjusting for age and health status.”  More...

Grantee Spotlight--Randall R. Bovbjerg, J.D.

Randall Bovbjerg, a principal research associate in the Health Policy Center of The Urban Institute, has followed the seemingly intractable issues surrounding medical malpractice since the mid-1970s. Other research interests focus on how to expand health coverage and the performance of state medical boards. During his career, he has written about health financing, competition, regulation, and the interactions of law and policy. At The Urban Institute since 1979, he has worked on numerous research projects and some demonstrations.

Under a recently completed HCFO grant, Bovbjerg examined the rapid rise of liability premiums, its implications for patient relations and safety reform, rationales for more open disclosure of risks and injuries, and how some hospitals have implemented policies improving transparency of outcomes to patients.

Bovbjerg reviewed the literature on medical liability insurance and the current malpractice “crisis”. He also studied safety and transparency, analyzing arguments that open disclosure may make patients less litigious. Finally, Bovbjerg and colleague Robert A. Berenson, M.D., conducted an exploratory case study of transparency by interviewing hospital risk managers and medical directors in four communities.

In today’s well-publicized debate among doctors, lawyers, and insurers about whether underlying legal costs or the insurance cycle has driven malpractice premiums up so sharply, both camps are “partly right,” notes Bovbjerg in a recent publication. Physician/insurer explanations are “more right”, he says because despite cyclical fluctuations, “over time prices must reflect underlying costs of claims, which are driven by legal and social trends, not insurance markets.”

In the current malpractice insurance crisis, practitioners’ “very real fear of liability reinforces traditional tendencies toward secrecy and hinders candid dialogue with patients,” says Bovbjerg. “More open disclosure may help promote early remedial intervention, system safety improvements, and an improved medical practice climate.” In an ideal world, he argues, “caregivers would tell patients and families whenever medical errors occur, and reasonable compensation would follow for those with preventable injuries.”

Through telephone interviews, Bovbjerg and Berenson found that hospitals in their four study communities practice more disclosure than was traditional, mainly because of Joint Commission on Accredidation of Healthcare Organizations (JCAHO) strictures. Disclosures do not necessarily include compensation, and hospital policies seemed little affected by the tort climate in their states. The extent of disclosure could not be carefully assessed but seemed lower than might be expected from research estimates of the rate of patient injury.

Bovbjerg currently serves on the Patient Safety Workgroup of the Federation of State Medical Boards and recently served on the Joint Commission on Accreditation of Healthcare Organization’s taskforce on alternatives to tort litigation and on the D.C. Health Care Reform Commission. He has taught (part time) for Duke University, Johns Hopkins University, and the University of Maryland. Previously, he was a state insurance regulator in Massachusetts and helped develop policy on methods of physician payment and insurance premium setting, licensure of health maintenance organizations, and regulation of Medigap and cancer insurance.

Bovbjerg received his A.B. from the University of Chicago and his J.D. from Harvard Law School, where he was a Felix Frankfurter Scholar. He follows his grandad’s lead in pronouncing his name Bo’ berg.

Articles from HCFO-funded project

Bovbjerg, R.R. “Patient Safety and Physician Silence,” Journal of Legal Medicine, 2004; Vol. 25, pp. 505–16.

Bovbjerg, R.R. “Malpractice Crisis and Reform,” Clinics in Perinatology, 2005; Vol. 32, pp. 203–33.

 

Special Solicitation: Use of Consumer Information

The Changes in Health Care Financing and Organization (HCFO) initiative is issuing a solicitation for proposals examining the use of consumer information in the consumer-directed health care (CDHC) model. Public and private policymakers need to better understand what kinds of information to provide to meet the new consumer demands that CDHC will generate, and how to provide that information in a way that enables consumers to make appropriate, timely decisions.

Recognizing that not all consumers have the same intellectual and cultural resources and cognitive abilities, it is also important for policymakers to understand how to tailor information to specific subgroups, such as non-English speaking persons, those with functional or cognitive impairments, or those with literacy problems. Therefore, the role of information intermediaries is also an important research area. Prior research, including a number of HCFO-sponsored projects, has begun exploring consumer decision-making. In addition, the Centers for Medicare and Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ) have funded considerable research developing tools such as HEDIS and CAHPS, and assessing their use. However, a number of unanswered questions remain.

Funds available under this solicitation total approximately $400,000. Although there is no pre-determined funding amount or grant period, up to three projects may be funded under this solicitation, depending on the scope of the projects proposed and the quality of the applications.

While this solicitation is open to all qualified applicants, we will require a letter indicating an intention to submit by Friday, July 22, 2005. This letter should be no more than two pages, and should include a brief description of the proposed research, an estimated budget and timeframe, and the qualifications of key staff (principal investigator). We may contact prospective applicants if we believe the proposed project does not fit within the scope of this special solicitation, but applicants should assume they may submit a full proposal if they are not contacted.

Projects submitted under this solicitation should follow the regular HCFO application instructions. Unlike the general HCFO solicitation, this program features a batched application process, and all proposals submitted under this solicitation will be reviewed simultaneously. If a letter of intent is submitted, applicants may complete a full proposal. Full proposals are due on or before Friday, August 19, 2005.

For more information, please see the full solicitation, which will be available on HCFO’s Web site beginning Friday, June 24.

 

 

Special Solicitation: Public Health Systems Research

The Changes in Health Care Financing and Organization (HCFO) initiative is issuing a solicitation for proposals addressing public health systems research topics. Research is needed that examines the functions and structure of public health agencies, the inputs to the public health system, the delivery of public health services, and the impact of these activities on population health.

Projects should apply health services research methods to address critical issues in public health policy, administration, and practice. This research should contribute to an enhanced understanding of public health systems, which comprise the array of public and private entities that engage in activities to promote health and prevent disease and injury at the population level. Funds available under this solicitation total approximately $500,000. There is no pre-determined funding amount or grant period. RWJF anticipates funding up to four projects that range from $100,000 to $300,000, depending on the scope of the projects proposed and their quality.

While this solicitation is open to all qualified applicants, we will require a letter indicating an intention to submit by Friday, August 5, 2005. This letter should be no more than two pages, and should include a brief description of the proposed research, an estimated budget and timeframe, and the qualifications of key staff (principal investigator). We may contact prospective applicants if we believe the proposed project does not fit within the scope of this special solicitation, but applicants should assume they may submit a full proposal if they are not contacted.

Projects submitted under this solicitation should follow the regular HCFO application instructions. Unlike the general HCFO solicitation, this program features a batched application process, and all proposals submitted under this solicitation will be reviewed simultaneously. If a letter of intent is accepted, applicants will be asked to complete a full proposal. Full proposals are due on or before Friday, September 2, 2005.

For more information, please see the full solicitation, which will be available on HCFO’s Web site beginning Friday, June 24.

 

MEWA Database: Offers Detailed State Information

One major way employers and self-employed individuals access health insurance coverage is through group purchasing arrangements, including association health plans (AHPs), multiple employer welfare arrangements (MEWAs), and health insurance purchasing coalitions (HIPCs). Millions of Americans rely on such arrangements to finance health care benefits, but little is known or understood about such arrangements and their regulation.

In a HCFO-funded study, Mila Kofman, J.D., and colleagues at Georgetown University have been examining the dynamics of pooled purchasing arrangements. Data from this study are accessible through a new database which contains information on M-1 Forms filed with the U.S. Department of Labor, Employee Benefits Security Administration (EBSA) in 2003. The purpose of the database is to help state regulators and investigators to identify MEWAs operating in their states. It allows for searches and provides information not available on the federal government's Web page, such as estimates of the number of people covered by each MEWA, estimates of the number of fully insured and self-insured MEWAs in each state, and names of MEWAs fully and/or self-insured operating in each state.

 

Interested in a Behind-the-Scenes Look at Health Policymaking in Washington?

AcademyHealth is hosting Health Policy Orientation: Behind the Scenes of Decision-Making in Washington, October 24-27, 2005, in Washington, D.C. This three-and-a-half day program will help participants gain an in-depth understanding of the formal and informal policymaking processes and the players who shape health policy.

 

The orientation includes presentations by leading experts, group discussions, hands-on tutorials, and a congressional site visit. Speakers are health policy insiders from both sides of the aisle with high-level experience at the White House, Congress, and key health agencies and associations. Limited space available. Register by Friday, September 30.

Recognizing Research with Impact

Health Services Research (HSR) Impact Award: Call for Nominations
Deadline: Friday, July 29, 2005

AcademyHealth requests nominations for its first annual HSR Impact Award, which recognizes outstanding health services research that has been successfully translated into health policy, management, or clinical practice and, as a result, had a positive impact on health and health care.

·          One-to-two awards will be given each year.

·          Winners receive a $2,000 cash prize and complimentary registration and travel to the 2006 National Health Policy Conference February 6-7, where the award will be presented.

·          Winning research will be published and disseminated as part of the AcademyHealth “HSR Impact” series.

For more information on the award, including eligibility criteria and the application process, visit www.academyhealth.org/awards/hsrimpacts.htm.

 

2006 NCHS/AcademyHealth Fellowship--Call for Applications

Application Deadline: January 9, 2006

 

This program brings visiting scholars in health services research-related disciplines to the National Center for Health Statistics (NCHS) to use NCHS data systems and collaborate on studies of interest to policymakers and the health services research community.

 

Applicants must:

·        Demonstrate training or experience in health services research.

·        Be at any stage in their careers from doctoral students to senior investigators.

·        Be at the dissertation phase of their programs (if doctoral students).

·        Be U.S. citizens, permanent residents, or able to acquire a valid work authorization.

 

For more information about the Fellowship and application requirements, visit www.academyhealth.org/nchs.